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Non-Hodgkin lymphoma (NHL) is cancer that begins in cells of the immune system. The immune system fights infections and other diseases.

Non-Hodgkin lymphoma begins when a lymphocyte (white blood cell) becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don`t die when they should. They don`t protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Because lymphatic tissue is in many parts of the body, non-Hodgkin lymphoma can start almost anywhere. Usually, it`s first found in a lymph node but it can spread to nearly any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow.

This type of cancer is more common in men than in women.

Types of non-Hodgkin lymphoma

The most common types are:

  • Diffuse large B-cell lymphoma: A type of B-cell non-Hodgkin lymphoma that is usually aggressive (fast-growing). It is the most common type of non-Hodgkin lymphoma, and is marked by rapidly growing tumors in the lymph nodes, spleen, liver, bone marrow, or other organs.
  • Follicular lymphoma: A type of B-cell non-Hodgkin lymphoma that is usually indolent (slow-growing). The tumor cells grow as groups to form nodules. There are several subtypes of follicular lymphoma.

Risk factors for non-Hodgkin lymphoma

  • Weakened immune system (such as from an inherited condition or certain drugs taken after an organ transplant)
  • Infections (such as Human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), Helicobacter pylori, Human T-cell leukemia/lymphoma virus type 1 (HTLV-1), Hepatitis C virus)
  • Age older than 60

Symptoms of non-Hodgkin lymphoma

  • Swollen, painless lymph nodes in the neck, armpits, or groin
  • Unintentional weight loss
  • Fever
  • Soaking night sweats
  • Severe itchiness
  • Coughing, trouble breathing, or chest pain
  • Weakness and tiredness that don`t go away
  • Pain, swelling, or a feeling of fullness in the abdomen leading to a loss of appetite, constipation, nausea, and vomiting

Diagnostic tests and exams for non-Hodgkin lymphoma

  • Personal and family history evaluation
  • Physical exam to check for swollen lymph nodes in your neck, underarms and groin, and swollen spleen and liver
  • Blood tests for a complete blood count (CBC) to check the number of white blood cells and other cells and substances, such as lactate dehydrogenase (LDH)
  • Blood chemistry tests
  • Chest x-rays to check for swollen lymph nodes or other signs of disease in your chest
  • Bone marrow aspiration and Biopsy (excisional biopsy or incisional biopsy) to check the tissue for lymphoma cells
  • CT scans of the chest, abdomen and pelvis
  • Lymph node biopsy
  • PET (positron emission tomography) scan

Treatment of non-Hodgkin lymphoma

The choice of treatment depends mainly on the following:

  • Type of non-Hodgkin lymphoma
  • Stage (where the lymphoma is found)
  • How quickly the cancer is growing (whether it is indolent or aggressive lymphoma)
  • Patient`s age
  • Whether the patient has other health problems

Treatment options include:

  • Chemotherapy, the use of drugs to treat cancer, is commonly used as the main form of treatment of non-Hodgkin`s lymphoma.
  • Immunotherapy using a drug called rituximab (Rituxan) that targets a molecule on the surface of B-cells.
  • Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance to an antibody that helps the immune system fight infection, and injecting the substance into the body.
  • Radiation therapy or radiotherapy uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.
  • Stem cell transplant or bone marrow transplant: If lymphoma returns after treatment, stem cell transplantation may be done. A transplant of your own blood-forming stem cells allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow. After you receive high-dose treatment, healthy blood-forming stem cells are given to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.

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